First Author: A.Yamasaki JAPAN
Co Author(s): S. Sasaki D. Nagase R. Uotani K. Inata Y. Inoue
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Anatomical outcomes of macular hole (MH) surgery have significantly improved in recent years. However, the postoperative visual acuity is occasionally poor despite anatomic closure. The postoperative subfoveal fluid is often detected on optical coherence tomography (OCT), and the incidence has reported to range from 34% to 49% in the previous report. Aim of our study is to retrospectively investigate relationship between postoperative visual acuity and persistent subfoveal fluid in surgically closed MHs.
Forty-eight eyes of 48 patients after idiopathic MH surgery including 23 male and 25 female, ranging 52 to 84 (mean 70.8) years old were enrolled in this study. Preoperative MH Stage were 3 cases of Stage 2, 32 cases of Stage 3, and 13 cases of Stage 4.
All patients underwent successful 23, or 25-gauge transconjunctival pars plana vitrectomy and internal limiting membrane (ILM) peeling with Brilliant Blue G (BBG: 0.25mg/ml) following 20% SF6 gas tamponade. Drainage of fluid through MH was not attempted in 41 patients. Seven cases underwent aggressive fluid drainage from MH before ILM peeling. Subfoveal fluid detected on postoperative spectral domain OCT and visual acuity at 2 weeks, 1, 6 and 12 months after surgery were evaluated.
In 41 cases after surgery without drainage from MH, 20 eyes showed subfoveal fluid 2 weeks after surgery. The cases were divided into 2 groups (A: cases with fluid and B: cases without fluid at 2weeks after surgery). Preoperative MH Stage was not significantly correlated with subfoveal fluid. The incidence of subfoveal fluid decrease to 30%, 15%, 7% at 1, 6, 12 months after surgery. logMAR of mean best corrected visual acuity (BCVA) were 0.25, 0.08, 0.07 in Group A, and 0.43, 0.30, 0.26 in Group B at 1, 6, 12 months after surgery, and visual recovery was significantly better in Group A compared with Group B. In 7 cases after surgery with aggressive drainage from MH, none of cases showed subfoveal fluid and BCVA were 0.30, 0.26, 0.23 at 1, 6, 12 months after surgery.
Closure of MH can be achieved in early days after surgery, however many cases closed with fluid in subretinal space. It is unclear what factors are associated with the development of persistent subfoveal fluid. Some previous reports showed subfoveal fluid has no negative effect on visual outcome, but causes delay of visual recovery after MH surgery. In our study, the cases with postoperative subfoveal fluid could have better visual acuity than the cases without fluid. We suggest that the fluid detected after MH surgery may be the viscous fluid occurred in subretinal space by chronic vitreous traction, and it takes time to be disappeared by complete penetration through whole retina and spread into vitreous cavity. By this presumption, the cases without postoperative subfoveal fluid are interpreted as long-standing macular hole attaining complete disappearance of viscous fluid, and the cases with postoperative subfoveal fluid are interpreted as short-standing macular hole preserving good retinal function. In addition, aggressive drainage from MH could not lead to favorable visual outcome in spite of no postoperative subfoveal fluid, compared with spontaneous absorption of subfoveal fluid.